NECESSITY, FUNCTION, AND CONFORMITY:
KRS 342.035(1) requires the commissioner of the Department of Workers' Claims
to promulgate administrative regulations to ensure that all fees, charges and reimbursements
for medical services under KRS Chapter 342 are limited to charges that are
fair, current, and reasonable for similar treatment of injured persons in the
same community for like services, where treatment is paid for by general health
insurers. KRS 342.035(4) requires the commissioner to promulgate an
administrative regulation establishing the workers' compensation medical fee
schedule for physicians. Pursuant to KRS 342.035, a schedule of fees is to be reviewed
and updated, if appropriate, every two (2) years on July 1. This administrative
regulation establishes the medical fee schedule for physicians.

(2) The medical fee schedule shall also
apply to other health care or medical services providers to whom a listed CPT
code is applicable unless:

(a) Another fee schedule of the Department
of Workers' Claims applies;

(b) A lower fee is required by KRS
342.035 or a managed care plan approved by the commissioner pursuant to 803 KAR
25:110; or

(c) An insurance carrier, self-insured
group, or self-insured employer has an agreement with a physician, medical bill
vendor, or other medical provider to provide reimbursement of a medical bill at
an amount lower than the medical fee schedule.

Section 3. Fee Computation. (1) The
appropriate fee for a procedure covered by the medical fee schedule shall be
obtained by multiplying a relative value unit for the medical procedure by the
applicable conversion factor; and

(2) The resulting fee shall be the
maximum fee allowed for the service provided.

Section 4. (1) A physician or
healthcare or medical services provider located outside the boundaries of
Kentucky shall be deemed to have agreed to be subject to this administrative
regulation if it accepts a patient for treatment who is covered under KRS
Chapter 342.

(2) Pursuant to KRS 342.035, medical
fees due to an out-of-state physician or healthcare or medical services
provider shall be calculated under the fee schedule in the same manner as for
an in-state physician.